Answer: b, c The body contains fuel reserves which it can mobilize and utilize during times of starvation or stress. By far the greatest energy component is fat, which is calorically dense since it provides about 9 calories/gram. Body protein comprises the next largest mass of utilizable energy, but amino acids yield only about 4 kcal/gram. Unlike fat reserves, body protein is not a storage form of energy but rather serves as a structural functional component of the body; loss of body protein, if severe, is associated with functional consequences. Glycogen stored in muscle and liver and free glucose have a trivial caloric value of less than 1000 kcal for a 70 kg male

Answer: b, c  The body contains fuel reserves which it can mobilize and utilize during times of starvation or stress. By far the greatest energy component is fat, which is calorically dense since it provides about 9 calories/gram. Body protein comprises the next largest mass of utilizable energy, but amino acids yield only about 4 kcal/gram. Unlike fat reserves, body protein is not a storage form of energy but rather serves as a structural functional component of the body; loss of body protein, if severe, is associated with functional consequences. Glycogen stored in muscle and liver and free glucose have a trivial caloric value of less than 1000 kcal for a 70 kg male
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Which of the following statement(s) is/are true concerning the indications and administration of nutritional support to cancer patients? a. Preoperative nutritional support should be provided to all patients with cancer b. To be effective, preoperative nutrition must be given for at least two weeks preoperatively c. Parenteral nutrition is the preferred route of feeding for all cancer patients d. Standard total parenteral nutrition solutions maintain integrity of the small bowel e. None of the above
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Fatty acids are a major energy source for the body. Which of the following statement(s) is/are true concerning the use of fatty acids as an energy source? a. Fatty acids are stored in adipocytes as triglycerides b. Hormone-sensitive lipase is present only in adipose tissue c. Fatty acids are released into the circulation traveling freely in plasma d. Approximately 25% of total nonprotein caloric needs supplied via total parenteral nutrition should be in the form of fat

Description : Fatty acids are a major energy source for the body. Which of the following statement(s) is/are true concerning the use of fatty acids as an energy source? a. Fatty acids are stored in ... 25% of total nonprotein caloric needs supplied via total parenteral nutrition should be in the form of fat

Last Answer : Answer: a, b, d In most tissues, fatty acids are readily oxidized for energy. They are especially important energy sources for the heart, liver and skeletal muscle. In ... administered to patients receiving total parenteral nutrition should comprise about 5-30% of total nonprotein caloric needs

Which of the following statements(s) is/are true concerning human energy requirement? a. In normal subjects, less than 5% of basal energy requirement is spent on cardiac output and the work of breathing b. Mechanical ventilation can decrease the energy expenditure for normal respiration c. For a 70 kg male, average resting energy consumption is almost 1500 kcal/day d. Similar increases in energy expenditures are associated with elective surgery and trauma or thermal injury

Description : Which of the following statements(s) is/are true concerning human energy requirement? a. In normal subjects, less than 5% of basal energy requirement is spent on cardiac output and the ... d. Similar increases in energy expenditures are associated with elective surgery and trauma or thermal injury

Last Answer : Answer: a, c Basal energy requirements are measured with the subject at rest when no external work is being done; the energy is used mainly for transport and synthetic work within cells. A ... average-sized adult who sustains a major burn rarely may require more than 3500 kcal/day for maintenance

Answer: e The role of nutritional support in the cancer patient remains an important component of overall therapy. Preoperative nutritional support should be given only to those patients who do not require an emergency operation and who have severe weight loss (> 15% of pre-illness body weight) and a serum albumen < 2.9 mg%. Preoperative nutrition (enteral or parenteral) should not be given for longer than 7 to 10 days. Enteral nutrition is always the preferred route of feeding cancer patients if the GI tract is functional. There are several benefits of using the bowel lumen for nutrient delivery. The trophic effects of enteral feeding on small bowel mucosa have been well described. The integrity of the mucosal lining is maintained and it may provide an effective barrier to intraluminal

Description : Answer: e The role of nutritional support in the cancer patient remains an important component of overall therapy. Preoperative nutritional support should be given only to those patients who ... of bowel rest; this atrophy is not reversed by currently available total parenteral nutrition solutions

Last Answer : Which of the following hormones can be expected to be released as part of the stress response? a. Antidiuretic hormone (ADH) b. Aldosterone c. Insulin d. Epinephrine nswer: a, b, d ... This hormone has the exact opposite effect of insulin, which promotes glucose storage and uptake by the cells

A 65-year old patient has colon carcinoma metastatic to the liver and lungs. He has had a weight loss of 10 kg. Cytokine-dependent tumor cachexia is attributable to which of the following? a. Increased glucose uptake and increased glycogen breakdown occur in this circumstance. b. Suppressed activity of lipoprotein lipase results from TNFa c. TNFa stimulates lipolysis d. The differentiation process of pre-adipocytes is impaired e. Partial reversal of differentiated adipocytes to pre-adipocyte morphology and gene expression occurs

Description : A 65-year old patient has colon carcinoma metastatic to the liver and lungs. He has had a weight loss of 10 kg. Cytokine-dependent tumor cachexia is attributable to which of the ... is impaired e. Partial reversal of differentiated adipocytes to pre-adipocyte morphology and gene expression occurs

Last Answer : Answer: a, b, c, d, e Tumor cachexia appears to be mediated by TNFa. Lipopolysaccharide (LPS), as well as other cytokines, activate a variety of inflammatory cells, most ... chronic syndromes of anorexia, weight loss, and cachexia that are associated with both chronic infection and malignancy

Which of the following statement(s) is/are true concerning protein/amino acid metabolism in man? a. The major source of amino acids is breakdown of circulating proteins b. The recommended daily allowance for protein may triple in critically ill patients c. Urinary nitrogen losses will approach 0 in the face of protein starvation d. Negative nitrogen balance refers to a decrease in nitrogen taken into the body versus the amount of nitrogen lost

Description : Which of the following statement(s) is/are true concerning protein/amino acid metabolism in man? a. The major source of amino acids is breakdown of circulating proteins b. The recommended daily ... balance refers to a decrease in nitrogen taken into the body versus the amount of nitrogen lost

Last Answer : Answer: b, d About 15% of the total body weight is made up of proteins, about half of which are intracellular and half extracellular. In man and other animals, dietary protein is the source of ... is exceeded by the amount of nitrogen lost in the urine, stool, skin, wounds, and fistula drainage

In contrast to a patient undergoing an elective operation, which of the following statement(s) is/are true concerning a patient who has suffered a multiple trauma? a. Basal metabolic rates are similar b. The patient is highly sensitive to insulin c. Utilization of the amino acids, glutamine and alanine, is similar to their composition in skeletal muscle d. Fat and protein stores are rapidly depleted

Description : In contrast to a patient undergoing an elective operation, which of the following statement(s) is/are true concerning a patient who has suffered a multiple trauma? a. Basal metabolic rates are ... is similar to their composition in skeletal muscle d. Fat and protein stores are rapidly depleted

Last Answer : Answer: b, d The degree of hypermetabolism is generally related to the severity of injury. Patients with long-bone fractures have a 15-25% increase in metabolic rate, whereas metabolic ... in injured subjects, if unfed, severely injured patients rapidly deplete their fat and protein stores

There are two properties of the cell necessary to maintain nonequilibrium cellular composition; the first is selectivity and the second is energy conversion. Which of the following statement(s) is/are true concerning energy converting transport? a. The site of energy conversion and transport in the plasma membrane involves the phospholipid component b. The Na+-K++-ATPase derives energy from hydrolysis of extracellular ATP c. In some systems, energy inherent in the transmembrane ion gradient can be used to drive transport of a second species d. Examples of species transported via secondary active transport include hydrogen ions, calcium, amino acids and glucose

Description : There are two properties of the cell necessary to maintain nonequilibrium cellular composition; the first is selectivity and the second is energy conversion. Which of the following statement(s ... transported via secondary active transport include hydrogen ions, calcium, amino acids and glucose

Last Answer : Answer: c, d The selectivity of the plasma membrane, although impressive, cannot account for the nonequilibrium composition of living cells. A cell can be maintained in a nonequilibrium state only by ... to drive the transport of a second species such as protons, calcium, amino acids, or glucose

Which of the following statement(s) is/are true concerning the proliferative phase of wound healing? a. The macrophage is the predominant cell type b. The pink or purple-red appearance of a wound is due to ingrowth and proliferation of endothelial cells c. Collagen, the dominant structural molecule of the wound matrix, contains two unique amino acids, hydroxyproline and hydroxylysine d. The predominant collagen type in a scar is type 3

Description : Which of the following statement(s) is/are true concerning the proliferative phase of wound healing? a. The macrophage is the predominant cell type b. The pink or purple-red appearance of a wound ... amino acids, hydroxyproline and hydroxylysine d. The predominant collagen type in a scar is type 3

Last Answer : Answer: b, c The proliferative phase of wound healing begins with the formation of a provisional matrix of fibrin and fibronectin as part of the initial clot formation. Initially, the provisional ... The principal collagen type scar is type 1, with lesser amounts of type 3 collagen also present

Total body mass is composed of an aqueous component and a nonaqueous component. The nonaqueous component is made up of which of the following? a. Liver b. Tendons c. Skeletal muscle d. Extracellular fluid e. Adipose tissue

Description : Total body mass is composed of an aqueous component and a nonaqueous component. The nonaqueous component is made up of which of the following? a. Liver b. Tendons c. Skeletal muscle d. Extracellular fluid e. Adipose tissue

Last Answer : Answer: b, e The nonaqueous portion of total body mass is made up of bones, tendons, and mineral mass as well as adipose tissue. The aqueous component contains the body cell ... and circulating blood cells. Also contributing to the aqueous portion is the interstitial fluid and intravascular volume

Answer: b Metabolic response to injury results in increased energy expenditure. If energy intake is less than expenditure, oxidation of body fat stores and erosion of lean body mass will occur with resultant loss of weight. When weight loss exceeds 10–15% of body weight, the complications of malnutrition interact with disease processes, with increased morbidity and mortality rates. The goal of nutritional support is maintenance of body cell mass and limitation of weight loss to less than 10% preinjury. The major impact of nutritional support in the trauma patient is to aid host defense. Under-nutrition may compromise the available host defense mechanism and may thus increase the likelihood of invasive sepsis, multiple organ system failure, and death. Resuscitation, oxygenation and arrest

Description : Answer: b Metabolic response to injury results in increased energy expenditure. If energy intake is less than expenditure, oxidation of body fat stores and erosion of lean body mass will occur ... requirements, caloric requirements should be distributed at a ratio of 70% as glucose and 30% as fat

Last Answer : Which of the following statement(s) is/are true concerning body fuel reserves? a. The largest fuel reserve in the body is skeletal muscle b. Fat provides about 9 calories/gram c. Free glucose and glycogen stores are a trivial fuel reserve d. Body protein is a valuable storage form of energy

Which of the following statements about total body water composition are correct? A. Females and obese persons have an increased percentage of body water. B. Increased muscle mass is associated with decreased total body water. C. Newborn infants have the greatest proportion of total body water. D. Total body water decreases steadily with age. E. Any person's percentage of body water is subject to wide physiologic variation.

Description : Which of the following statements about total body water composition are correct? A. Females and obese persons have an increased percentage of body water. B. Increased muscle mass is associated with ... age. E. Any person's percentage of body water is subject to wide physiologic variation.

Last Answer : Answer: CD DISCUSSION: Since fat contains little water, lean persons with a proportionately greater muscle mass have a greater than expected volume of total body water. Likewise, the ... decreases steadily and significantly with age. The actual figure for a healthy person is remarkably constant

Increasing evidence has implicated gram-negative bacterial lipopolysaccharide (LPS endotoxin) as the portion of the gram-negative bacterial cell membrane responsible for many, if not all the toxic effects that occur during gram-negative bacterial sepsis. The following statement(s) is/are true concerning LPS and the host response. a. The LPS molecule can in itself cause physiologic responses similar to that seen during gram-negative bacterial sepsis b. LPS triggers host macrophages to release a variety of cytokines including TNF-a, IL-1a, and IL-1b, IL-6, and IFN-a c. Excessive cytokine production is not associated with detrimental consequences d. TNFa and IL-1b appear to be the primary mediators within the host, exerting deleterious effects on the host when excessive amounts reach the syst

Description : Increasing evidence has implicated gram-negative bacterial lipopolysaccharide (LPS endotoxin) as the portion of the gram-negative bacterial cell membrane responsible for many, if not all the ... host, exerting deleterious effects on the host when excessive amounts reach the systemic circulation

Last Answer : Answer: a, b, d The LPS molecule exerts diverse effects on the mammalian host. Immunologic responses to LPS include nonspecific polyclonal B-cell proliferation, macrophage activation and ... deleterious effects on the host only after large amounts are secreted and reach the systemic circulation

Which of the following statements concerning perioperative nutrition is true concerning the above-described patient? a. Since the patient’s weight had been stable with no preoperative nutritional deficit, 5% dextrose intravenous solutions are adequate for the initial postoperative source of nutrition b. Preoperative immunologic status should be determined including total peripheral lymphocyte count and delayed hypersensitivity reaction to determine skin-test response to common antigens c. Routine postoperative fluid administration with intravenous 5% glucose solutions can provide the calories to meet basal energy requirements d. A jejunal feeding catheter should be placed at the time of surgery for postoperative enteral feeding

Description : Which of the following statements concerning perioperative nutrition is true concerning the above-described patient? a. Since the patient's weight had been stable with no preoperative nutritional deficit ... feeding catheter should be placed at the time of surgery for postoperative enteral feeding

Last Answer : Answer: a Most patients undergoing elective operations are adequately nourished. Unless the patient has suffered significant preoperative malnutrition, characterized by weight loss greater than ... gastrointestinal surgery, this technique would not appear indicated in the patient described above

Which of the following statement(s) is/are true concerning metabolic derangements in sepsis and the systemic inflammatory response syndrome which may follow progressive shock? a. Alterations in glucose metabolism lead to the development of efficient substrate utilization b. A progressive rise in serum triglyceride levels result from less efficient clearance and increased hepatic lipogenesis c. A net negative nitrogen balance occurs due to the oxidative metabolism of proteins to meet energy needs d. The serum aromatic amino acids fall rapidly as they are actively used in oxidative metabolism

Description : Which of the following statement(s) is/are true concerning metabolic derangements in sepsis and the systemic inflammatory response syndrome which may follow progressive shock? a. Alterations in glucose ... The serum aromatic amino acids fall rapidly as they are actively used in oxidative metabolism

Last Answer : Answer: b, c A broad spectrum of metabolic abnormalities become apparent in sepsis and the systemic inflammatory response syndrome following shock. Disruption of the normal cycles of carbohydrate, ... acetyl coenzyme A. This results in reduced serum level of leucine, isoleucine and valine

Essential fatty acid deficiency may complicate total parenteral nutrition (TPN). Which of the following statements are true? A. Essential fatty acid deficiency may be prevented by the administration of 1% to 2% of total calories as fat emulsion. B. Fat-free parenteral nutrition results in the appearance of plasma abnormalities, indicating essential fatty acid deficiency, within 7 to 10 days of initiation. C. An abnormal plasma eicosatrienoic-arachidonic acid ratio is always associated with essential fatty acid deficiency. D. Following initiation of fat-free parenteral nutrition, dry, scaly skin associated with a maculopapular rash indicates essential fatty acid deficiency.

Description : Essential fatty acid deficiency may complicate total parenteral nutrition (TPN). Which of the following statements are true? A. Essential fatty acid deficiency may be prevented by the ... , dry, scaly skin associated with a maculopapular rash indicates essential fatty acid deficiency.

Last Answer : Answer: BD DISCUSSION: Biochemical evidence of essential fatty acid deficiency may occur as early as 7 to 10 days following initiation of fat-free parenteral nutrition. The decrease in ... essential to the diagnosis of essential fatty acid deficiency, but this plasma abnormality is often present

Which of the following statement(s) concerning intravenous nutritional support is/are true? a. Concentrations of glucose no higher than 5% should be used to avoid peripheral vein sclerosis b. A major disadvantage of the peripheral technique is limited caloric delivery c. If total parenteral nutrition is required, access to the superior vena cava via the external jugular vein is the most suitable site d. Venous thrombosis is an uncommon complication for long-term central vein catheterization

Description : Which of the following statement(s) concerning intravenous nutritional support is/are true? a. Concentrations of glucose no higher than 5% should be used to avoid peripheral vein sclerosis ... suitable site d. Venous thrombosis is an uncommon complication for long-term central vein catheterization

Last Answer : Answer: b Although peripheral access can be used for intravenous nutrition, the major disadvantage of this technique is limited caloric delivery to meet catabolic demands within tolerated fluid ... studies that use phlebography or radionucleotide venography indicate the incidence is as high as 35%

Starvation starts with (a) Utilization of glucose by cells (b) Utilization of glycogen by cells (c) Utilization of fat & protein by cells (d) None of the above

Description : Starvation starts with (a) Utilization of glucose by cells (b) Utilization of glycogen by cells (c) Utilization of fat & protein by cells (d) None of the above

Last Answer : (c) Utilization of fat & protein by cells

Which of the following statement(s) is/are true concerning translation of the mRNA message to protein synthesis? a. An adaptor molecule, tRNA, recognizes specific nucleic acid bases and unites them with specific amino acids b. Covalent attachment of tRNA to amino acids is energy dependent c. The formation of a peptide bond between the growing peptide chain and the free amino acid occurs in the free cytoplasm d. Complete protein synthesis takes hours

Description : Which of the following statement(s) is/are true concerning translation of the mRNA message to protein synthesis? a. An adaptor molecule, tRNA, recognizes specific nucleic acid bases and unites them ... and the free amino acid occurs in the free cytoplasm d. Complete protein synthesis takes hours

Last Answer : Answer: a, b The synthesis of protein involves conversion from a four-letter nucleotide language to one of 20 chemically distinct amino acids. This process is referred to as ... translation and be moving down the mRNA molecules simultaneously, thus increasing the rate of protein synthesis

In the nutritional support of patients with cancer, which of the following statements is/are true? A. Nutritional support benefits the patient's lean body mass but does not enable the tumor to grow. B. In experimental animals, the growth of implanted tumors is directly proportional to the amount of calories and protein supplied. C. Prospective randomized trials of nutritional support utilizing chemotherapy and radiation therapy have revealed benefits to patients receiving total parenteral nutrition. D. Studies of nutritional support for patients with cancer about to undergo surgery revealed decreased morbidity and mortality, especially morbidity from sepsis.

Description : In the nutritional support of patients with cancer, which of the following statements is/are true? A. Nutritional support benefits the patient's lean body mass but does not enable ... with cancer about to undergo surgery revealed decreased morbidity and mortality, especially morbidity from sepsis.

Last Answer : Answer: B DISCUSSION: The problem with the patient with cancer is a very vexing one. Clearly, one of the metabolic effects of cancer, cachexia, affects patients in the last quartile ... undoubtedly reveal that there are certain nutrients that tumors require, which probably should be best avoided

Which of the following complications of TPN are appropriately managed with the listed treatment? a. Air embolism—place patient in reverse Trendelenburg and the left lateral decubitus position and aspirate venous air b. Hyperchloremic metabolic acidosis—give sodium and potassium as acetate salts c. Carbon dioxide retention—decrease glucose calories and replace with fat d. Line sepsis—intravenous antibiotics

Description : Which of the following complications of TPN are appropriately managed with the listed treatment? a. Air embolism-place patient in reverse Trendelenburg and the left lateral decubitus position ... dioxide retention-decrease glucose calories and replace with fat d. Line sepsis-intravenous antibiotics

Last Answer : Answer: b, c A number of complications of TPN can occur which can be divided into three types: mechanical, metabolic, and infectious

The word ____ on a label, means that a product contains no amount of, or only trivial or “physiologically inconsequential” amounts of, one or more of these components: fat, saturated fat, cholesterol, sodium, sugars, and calories. a. Low c. Lean b. Free d. Reduced

Description : The word ____ on a label, means that a product contains no amount of, or only trivial or “physiologically inconsequential” amounts of, one or more of these components: fat, saturated fat, cholesterol, sodium, sugars, and calories. a. Low c. Lean b. Free d. Reduced

Last Answer : b. Free

Which of the following statement(s) is/are true concerning the multiorgan failure syndrome (MOFS)? a. Changes in the splanchnic and pulmonary microcirculation are critical to the development of MOFS b. Tissue fixed microphages, including the liver Kupffer cell, have little role in the development of MOFS c. MOFS represents systemic consequences of loss of homeostatic control of local inflammation and microcirculatory hypoperfusion d. The nature of MOFS is highly dependent upon the etiology of the underlying problem

Description : Which of the following statement(s) is/are true concerning the multiorgan failure syndrome (MOFS)? a. Changes in the splanchnic and pulmonary microcirculation are critical to the development of MOFS ... d. The nature of MOFS is highly dependent upon the etiology of the underlying problem

Last Answer : Answer: a, c The nature of multiorgan failure syndrome (MOFS) is that of a diffuse cellular injury, developing systemically as a consequence of losing homeostatic control of local ... of microorganism. In noninfectious cases, the response also appears independent of the specific underlying cause

Energy is stored in liver and muscles in the form of – (1) carbohydrate (2) fat (3) protein (4) glycogen

Description : Energy is stored in liver and muscles in the form of – (1) carbohydrate (2) fat (3) protein (4) glycogen

Last Answer : (4) glycogen Explanation: Muscle and liver cells have a high capacity for glycogen storage because they require fast access when the need for it arises.

Skeletal muscle breakdown produces predominantly liberation of which two amino acids? A. Lysine. B. Tyrosine. C. Alanine. D. Glutamine. E. Arginine.

Description : Skeletal muscle breakdown produces predominantly liberation of which two amino acids? A. Lysine. B. Tyrosine. C. Alanine. D. Glutamine. E. Arginine.

Last Answer : Answer: CD DISCUSSION: Alanine is released from skeletal muscle and extracted by the liver, where it is converted to new glucose. Glutamine is also released from muscle and participates in ... these two amino acids account for approximately two thirds of the nitrogen released from skeletal muscle

Glucose overload results in increased CO 2 production. Which of the following statements are true? A. In patients with respiratory insufficiency, administration of glucose as a principal calorie source is contraindicated. B. In patients with pulmonary infection and sepsis, calorie support should consist of 95% fat and 5% glucose. C. In Askanazi's study, increased CO 2 production and difficulty in weaning was associated only with pronounced overfeeding. D. CO 2 production should be measured in most patients who are supported by respirators in intensive care units and are receiving nutritional support.

Description : Glucose overload results in increased CO 2 production. Which of the following statements are true? A. In patients with respiratory insufficiency, administration of glucose as a principal calorie ... who are supported by respirators in intensive care units and are receiving nutritional support.

Last Answer : Answer: C DISCUSSION: Few papers have excited as much interest as that by Askanazi, Kinney, and co-workers, which demonstrated that glucose calories given to patients with severe respiratory ... the caloric requirement and glucose for the remainder, without much fear of excessive CO 2 production

Which of the following statement(s) is/are true concerning heparin-associated thrombocytopenia? a. Heparin-associated thrombocytopenia occurs only in the face of over anticoagulation with heparin b. Severe thrombocytopenia (platelet count less than 100,000) is seen in less than 10% of patients treated with heparin c. Heparin-associated thrombocytopenia is due to the aggregation of platelets and may result in thrombosis or embolic episodes d. Heparin-associated thrombocytopenia may be seen within hours of initiation of heparin therapy

Description : Which of the following statement(s) is/are true concerning heparin-associated thrombocytopenia? a. Heparin-associated thrombocytopenia occurs only in the face of over anticoagulation with heparin b. ... d. Heparin-associated thrombocytopenia may be seen within hours of initiation of heparin therapy

Last Answer : Answer: b, c Heparin-associated thrombocytopenia occurs in 0.6% to 30% of patients who receive heparin, although severe thrombocytopenia (platelet counts less than 100,000) is seen in ... as coating on pulmonary artery catheters or low rate infusion into arterial catheters may cause this syndrome

Hepatic abnormalities have been noted in adults since the beginning of hyperalimentation. Which of the following statements are true? A. Hepatic steatosis appears to be associated with an overload of glucose. B. Hepatic steatosis is usually associated with abnormalities in hepatic enzymes. C. Hyperbilirubinemia is inevitably associated with hepatic steatosis. D. Abnormalities in the portal insulin-glucagon ratio are thought to be causative of hepatic steatosis in experimental animals.

Description : Hepatic abnormalities have been noted in adults since the beginning of hyperalimentation. Which of the following statements are true? A. Hepatic steatosis appears to be associated with an overload ... insulin-glucagon ratio are thought to be causative of hepatic steatosis in experimental animals.

Last Answer : Answer: AD DISCUSSION: The most common metabolic complication of TPN in adults is hepatic steatosis. Unlike the hepatic abnormalities in children, which may progress to cholestasis, liver damage, ... glucagon, which is elicited by certain amino acids, results in the mobilization of hepatic lipid

Altering the amino acid profile in total parenteral nutrition solutions can be of benefit in certain conditions. Which of the following conditions are associated with a benefit by supplementation with the amino acid type listed? a. Acute renal failure and essential amino acids b. Hepatic failure and aromatic amino acids c. Short gut syndrome and glutamine d. Chronic renal failure and essential amino acids

Description : Altering the amino acid profile in total parenteral nutrition solutions can be of benefit in certain conditions. Which of the following conditions are associated with a benefit by supplementation with the ... c. Short gut syndrome and glutamine d. Chronic renal failure and essential amino acids

Last Answer : Answer: a, c In a number of conditions, altering the amino acid profile of the total parenteral nutrition solution can be of benefit. TPN with amino acids of high biologic value ... Glutamine-enriched TPN partially attenuates villous atrophy and may be useful in treatment of short gut syndrome

A modified amino acid solution with increased equimolar branched-chain amino acids and decreased aromatic amino acids has been proposed for patients with hepatic insufficiency. Which of the following statements is/are true? A. This formulation is proposed for the use of patients with fulminant hepatitis. B. Nitrogen balance is achieved in such patients with amounts of 40 gm. of amino acids per 24 hours. C. The use of 80 to 100 gm. of such solutions is associated with hepatic encephalopathy. D. In some studies of surgical patients, improvements in mortality have been reported.

Description : A modified amino acid solution with increased equimolar branched-chain amino acids and decreased aromatic amino acids has been proposed for patients with hepatic insufficiency. Which of the following ... D. In some studies of surgical patients, improvements in mortality have been reported.

Last Answer : Answer: D DISCUSSION: The use of modified amino acid solutions is based on the false neurotransmitter hypothesis of the cause of hepatic coma. According to this hypothesis, the imbalance ... in a group of patients with cirrhosis, decreasing morbidity and showing a trend toward decreased mortality

Infectious disease transmission during blood transfusions is of clinical significance to surgeons and of major importance to patients contemplating surgery potentially associated with the need for blood administration. Which of the following statement(s) is/are true concerning the transmission of infectious disease during blood transfusions? a. Post-transfusion hepatitis is usually due to hepatitis B b. Hepatitis and HIV transmission is greatest with the administration of pooled plasma products such as serum albumin c. The most important cause of post-transfusion disease in immunosuppressed patients is CMV infection d. The risk of HIV transmission in blood transfusions is significantly less than the risk of hepatitis transmission

Description : Infectious disease transmission during blood transfusions is of clinical significance to surgeons and of major importance to patients contemplating surgery potentially associated with the need for ... transmission in blood transfusions is significantly less than the risk of hepatitis transmission

Last Answer : Answer: c, d The most common infectious diseases transmitted during blood transfusions include viral hepatitis, CMV, and HIV infection. Post-transfusion hepatitis in 90% of cases consists of ... infectious disease transmission, the risks of HIV transmission is markedly less than that of hepatitis

Before starvation (a) Glucose is utilized (b) Glycogen is consumed (c) Fat is consumed (d) Glucose & Glycogen consumed

Description : Before starvation (a) Glucose is utilized (b) Glycogen is consumed (c) Fat is consumed (d) Glucose & Glycogen consumed

Last Answer : (d) Glucose & Glycogen consumed

Answer: a, b, c, d Free oxygen radicals are chemical species that are intermediates in the normal process of cellular respiration. Oxidants that are free radicals have been implicated as initiators of reactions which lead to a variety of cellular injuries. Oxidants are derived from several sources, notably phagocytes. Among the effects of oxygen free radicals are membrane lipid peroxidation, DNA strand breaks, cytoskeletal disassembly and inhibition of glucose metabolism leading to decreased cellular ATP concentrations. (Figure 6-16) 187 Which of the following acute-phase protein levels are increased in human plasma following acute inflammation? a. C-reactive protein b. Serum amyloid c. a -Proteinase inhibitor d. Fibrinogen e. Albumin

Description : Answer: a, b, c, d Free oxygen radicals are chemical species that are intermediates in the normal process of cellular respiration. Oxidants that are free radicals have been implicated as initiators of ... a. C-reactive protein b. Serum amyloid c. a -Proteinase inhibitor d. Fibrinogen e. Albumin

Last Answer : Answer: a, b, c, d The acute-phase response is a series of homeostatic responses of the organism to tissue injury in infection and inflammation. After an inflammatory stimulus occurs, a number ... 30% to 50% of the level before injury. The reason for the decrease in production is poorly understood

______ is a multibranched polysaccharide of glucose that serves as a form of energy storage in animals and fungi. (1) Cellulose (2) Glycogen (3) Pectin (4) Chitin

Description : ______ is a multibranched polysaccharide of glucose that serves as a form of energy storage in animals and fungi. (1) Cellulose (2) Glycogen (3) Pectin (4) Chitin

Last Answer : (2) Glycogen Explanation: Glycogen is a multi branched polysaccharide of glucose that serves as a form of energy storage in humans, animals, and fungi. The polysaccharide structure represents the ... Glycogen is the analogue of starch, a glucose polymer that functions as energy storage in plants.

______ is a multibranched polysaccharide of glucose that serves as a form of energy storage in animals and fungi. (1) Cellulose (2) Glycogen (3) Pectin (4) Chitin

Description : ______ is a multibranched polysaccharide of glucose that serves as a form of energy storage in animals and fungi. (1) Cellulose (2) Glycogen (3) Pectin (4) Chitin

Last Answer : (2) Glycogen Explanation: Glycogen is a multi branched polysaccharide of glucose that serves as a form of emery storage in humans animals, and fungi.

____ is a multibranched polysaccharide of glucose that serves as a form of energy storage in animals and fungi. (1) Cellulose (2) Glycogen (3) Pectin (4) Chitin

Description : ____ is a multibranched polysaccharide of glucose that serves as a form of energy storage in animals and fungi. (1) Cellulose (2) Glycogen (3) Pectin (4) Chitin

Last Answer : Glycogen

Which one of the following pairs is mismatched? a. Protein - amino acids b. Nucleic acid - nucleotides c. Fats - glycogen d. Starch - glucose

Description : Which one of the following pairs is mismatched? a. Protein - amino acids b. Nucleic acid - nucleotides c. Fats - glycogen d. Starch - glucose

Last Answer : c. Fats - glycogen

What is the major form of caloric storage in human body? (A) ATP (B) Glycogen (C) Creatine phosphate (D) triacylglycerol

Description : What is the major form of caloric storage in human body? (A) ATP (B) Glycogen (C) Creatine phosphate (D) triacylglycerol

Last Answer : Answer : C

A diabetic develops a severe perineal infection with skin necrosis, subcutaneous crepitance, and drainage of a thin, watery, grayish and foul-smelling fluid. Management should consist of: a. Gram stain of the fluid, which will likely demonstrate multiple bacteria including predominantly gram-positive rods b. A CT scan is indicated in a stable patient to define the extent of the disease c. Broad spectrum antibiotics followed with prompt extensive debridement is indicated d. A safe guideline is to resect infected necrotic tissue so that a several centimeter margin of grossly normal, healthy tissue can be achieved e. A colostomy is of little benefit in this situation

Description : A diabetic develops a severe perineal infection with skin necrosis, subcutaneous crepitance, and drainage of a thin, watery, grayish and foul-smelling fluid. Management should consist of: a. Gram stain ... normal, healthy tissue can be achieved e. A colostomy is of little benefit in this situation

Last Answer : Answer: a, b, c, d The presence of severe perineal infection (referred to as Fournier gangrene when this process involves the perineum and scrotum in males) is associated with a ... often provides improved wound care and patient management, although it is not invariably a positive outcome

A major problem in nutritional support is identifying patients at risk. Recent studies suggest that these patients can be identified. Which of the following findings identify the patient at risk? A. Weight loss of greater than 10% over 2 to 4 months. B. Serum albumin of less than 3 gm. per 100 ml. in the hydrated state. C. Malnutrition as identified by global assessment. D. Serum transferrin of less than 220 mg. per 100 ml. E. Functional impairment by history.

Description : A major problem in nutritional support is identifying patients at risk. Recent studies suggest that these patients can be identified. Which of the following findings identify the patient at risk? A. Weight ... transferrin of less than 220 mg. per 100 ml. E. Functional impairment by history.

Last Answer : Answer: ABCDE DISCUSSION: All of these are at least partially correct. It is not clear whether weight loss of 10% or 15% is the required threshold, but it certainly is close. Serum ... the hands of an experienced observer is quite a reasonable way of approaching and identifying patients at risk

A 59-year-old trauma patient has suffered multiple septic complications including severe pneumonia, intraabdominal abscess, and major wound infection. He has now developed signs of multisystem organ failure. Which of the following statement(s) is/are true concerning necessary changes to be made in his nutritional management? a. Carbohydrate load should be reduced in the face of respiratory failure b. In patients with renal failure, protein intake should be diminished c. During hemodialysis protein intake should be limited to the same extent d. In patients with hepatic failure, carbohydrate load should be increased

Description : A 59-year-old trauma patient has suffered multiple septic complications including severe pneumonia, intraabdominal abscess, and major wound infection. He has now developed signs of multisystem organ ... the same extent d. In patients with hepatic failure, carbohydrate load should be increased

Last Answer : Answer: a, b The most severe complication of sepsis is multiple system organ dysfunction syndrome, which may result in death. The development of organ failure requires changes in the ... should be provided as fat emulsion. If encephalopathy develops, protein load should also be reduced0

Each gram of fat contains ____ kcal. a. 8 c. 7 b. 9 d. 6

Description : Each gram of fat contains ____ kcal. a. 8 c. 7 b. 9 d. 6

Last Answer : b. 9

Oxidation of which substance in the body yields the most calories (A) Glucose (B) Glycogen (C) Protein (D) Lipids

Description : Oxidation of which substance in the body yields the most calories (A) Glucose (B) Glycogen (C) Protein (D) Lipids

Last Answer : D

Oxidation of which substance in the body yields the most calories (A) Glucose (B) Glycogen (C) Protein (D) Lipids

Description : Oxidation of which substance in the body yields the most calories (A) Glucose (B) Glycogen (C) Protein (D) Lipids

Last Answer : (D) Lipids

Which of the following statement(s) is/are true concerning methods of nutritional support? a. Optimal results for enteral feedings are achieved with approximately half of calories supplied as carbohydrate and half as fat b. Diarrhea is the most common complication of enteral feeds and is due to the high osmolarity of the carbohydrate components c. The hyperosmolar nature of parenteral fat solutions requires central venous administration d. Approximately 25–50% of calories should be provided as fat emulsion in patients receiving total parenteral nutrition

Description : Which of the following statement(s) is/are true concerning methods of nutritional support? a. Optimal results for enteral feedings are achieved with approximately half of calories supplied as ... -50% of calories should be provided as fat emulsion in patients receiving total parenteral nutrition

Last Answer : Answer: a, b, d Most formulas for enteral feeding range from 1.0 to 2 cal/ml and include 3 to 7% protein. Most of the calories are supplied as glucose or sucrose, so that the solutions ... up to 25 to 50% of calories each day as fat emulsion may optimize the delivery of this caloric delivery

Most hormone receptors are localized on the cell membrane and transduce hormone binding into altered levels of intracellular messengers. A limited number of intracellular receptors do exist. Which of the following statement(s) is/are true concerning intracellular receptors? a. The messengers or hormones must by lipophilic b. These intracellular receptors generally regulate protein synthesis c. The intracellular receptors are located entirely in the nucleus of the cell d. A heat-shock protein serves as an inhibitor protein blocking the DNA-binding domain of the steroid receptor

Description : Most hormone receptors are localized on the cell membrane and transduce hormone binding into altered levels of intracellular messengers. A limited number of intracellular receptors do exist. Which of ... protein serves as an inhibitor protein blocking the DNA-binding domain of the steroid receptor

Last Answer : Answer: a, d Although most hormone and other messenger receptors are extracellular, intracellular receptors have been identified. The hormone messengers involved for these receptors are primarily ... DNA-binding domain of the receptor. Activation involves the dissociation of the inhibitor protein

Which of the following is/are not associated with increased likelihood of infection after major elective surgery? A. Age over 70 years. B. Chronic malnutrition. C. Controlled diabetes mellitus. D. Long-term steroid use. E. Infection at a remote body site.

Description : Which of the following is/are not associated with increased likelihood of infection after major elective surgery? A. Age over 70 years. B. Chronic malnutrition. C. Controlled diabetes mellitus. D. Long-term steroid use. E. Infection at a remote body site.

Last Answer : Answer: C DISCUSSION: Controlled diabetes mellitus has been shown repeatedly not to be associated with increased likelihood of incisional infection provided one avoids operations on body parts ... site-are well-recognized adverse predictive factors and are identified in tables within the chapter

A 67-year-old male presents with an intraabdominal abscess secondary to perforated sigmoid diverticulitis. The following statement(s) is/are true concerning his intraabdominal abscess. a. Culture will likely reveal a solitary organism b. Both aerobic and anaerobic islets are encountered in 50% of specimens c. The most common aerobic islet will be likely E. coli and other gram-negative enteric bacilli d. The most common anaerobic islet will be a Bacteroides species

Description : A 67-year-old male presents with an intraabdominal abscess secondary to perforated sigmoid diverticulitis. The following statement(s) is/are true concerning his intraabdominal abscess. a. Culture will ... gram-negative enteric bacilli d. The most common anaerobic islet will be a Bacteroides species

Last Answer : Answer: b, c, d Typically an intraabdominal infection results in perforation of a hollow viscus and the ensuing contamination of a normally sterile peritoneal cavity. The normal ... Bacteroides species (especially B. fragilis, Clostridium), and anaerobic cocci are most consistently isolated

A 67-year-old male with advanced cholangiocarcinoma develops gram-negative sepsis. Excessive bleeding is noted around vascular catheters and from needle puncture sites. The diagnosis of disseminated intervascular coagulation (DIC) is considered. Which of the following laboratory test(s) is/are indicative of DIC? a. Decreased platelet count b. Decreased fibrinogen level c. Normal prothrombin time d. Elevated fibrin split products

Description : A 67-year-old male with advanced cholangiocarcinoma develops gram-negative sepsis. Excessive bleeding is noted around vascular catheters and from needle puncture sites. The diagnosis of disseminated ... b. Decreased fibrinogen level c. Normal prothrombin time d. Elevated fibrin split products

Last Answer : Answer: a, b, d Disseminated intravascular coagulation (DIC) is the primary form of acute thrombosis. Causes of this syndrome include abruptio placenta, gram-positive and gram-negative sepsis, ... decline in the platelet count and fibrinogen level, along with an elevation of fibrin split products

This major protein component of connective tissue in mammals comprises most of the organic matter of skin, tendons, bones, and teeth, and occurs as fibrous inclusions in most other body structures. Is this material: a) elastin b) collagen c) fatty acids d) keratin

Description : This major protein component of connective tissue in mammals comprises most of the organic matter of skin, tendons, bones, and teeth, and occurs as fibrous inclusions in most other body structures. Is this material: a) elastin b) collagen c) fatty acids d) keratin

Last Answer : ANSWER: B -- collagen 

The caloric value of lipids is (A) 6.0 Kcal/g (B) 9.0 Kcal/g (C) 15.0 Kcal/g (D) 12.0 Kcal/g

Description : The caloric value of lipids is (A) 6.0 Kcal/g (B) 9.0 Kcal/g (C) 15.0 Kcal/g (D) 12.0 Kcal/g

Last Answer : Answer : B